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Detection of Anti-MDA5 Autoantibodies Using HeLa Cells and Immunocytochemistry with Light Microscopy
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Clinical features of dermatomyositis associated with anti-MDA5 antibodies by age

Koichi Yamaguchi1, Aya Yamaguchi1, Yuji Onuki1

  • 1Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Gunma, Japan.

Modern Rheumatology
|March 10, 2020
PubMed
Abstract

Insights

Age significantly impacts outcomes for anti-melanoma differentiation-associated gene 5 (MDA5) autoantibody-positive dermatomyositis (DM) patients. Older individuals (≥60 years) face worse prognoses, particularly with rapidly progressive interstitial lung disease (ILD).

Area of Science:

  • Rheumatology
  • Pulmonology
  • Immunology

Background:

  • Anti-melanoma differentiation-associated gene 5 (MDA5) autoantibodies are associated with interstitial lung disease (ILD) in dermatomyositis (DM).
  • Age at onset is a known poor prognostic factor in anti-MDA5 positive DM-ILD.
  • The specific impact of age on clinical presentation and outcomes in anti-MDA5 positive DM remains incompletely understood.

Purpose of the Study:

  • To investigate the influence of age on clinical features, treatment, and prognosis in anti-MDA5 autoantibody-positive DM patients.
  • To compare outcomes between younger (<60 years) and older (≥60 years) patient cohorts.
  • To identify specific challenges and mortality factors in elderly anti-MDA5 positive DM patients.

Main Methods:

  • Retrospective analysis of 40 anti-MDA5 autoantibody-positive DM patients.
  • Stratification of patients into two age groups: <60 years and ≥60 years.
  • Comparison of clinical characteristics, laboratory findings, high-resolution computed tomography (HRCT) data, treatment strategies, complications (infections), and survival rates between groups.

Main Results:

  • Older patients (≥60 years) exhibited significantly fewer mucocutaneous symptoms like arthralgia/arthritis and skin ulceration compared to younger patients.
  • The older cohort demonstrated significantly higher mortality rates.
  • Older patients were more frequently complicated by rapidly progressive interstitial lung disease (RP-ILD), necessitating combination immunosuppressive therapy, which proved often ineffective, alongside challenges in infection control.

Conclusions:

  • Age is a critical determinant of clinical phenotype and prognosis in anti-MDA5 autoantibody-positive DM.
  • Elderly patients (≥60 years) with anti-MDA5 positive DM have a poorer prognosis, characterized by a higher risk of RP-ILD and increased mortality.
  • Standard combination immunosuppressive therapies may be less effective for RP-ILD in older DM patients, highlighting the need for age-specific treatment strategies.
Keywords:
Anti-MDA5 autoantibodymyositis-associated antibodyolder peoplerapidly progressive interstitial lung disease

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